Provider Demographics
NPI:1346946647
Name:FRAZIER, CHANTILLIE JEANINE
Entity Type:Individual
Prefix:
First Name:CHANTILLIE
Middle Name:JEANINE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1378
Mailing Address - Country:US
Mailing Address - Phone:419-810-6849
Mailing Address - Fax:
Practice Address - Street 1:416 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1378
Practice Address - Country:US
Practice Address - Phone:419-810-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000310852Medicaid